| NPI | 1023605417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WHOBREY Provider Enrollment 502-630-7249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3747P1801X Technician Personal Care Attendant |
| Additional Taxonomies | 261QA0600X Clinic/Center Adult Day Care |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2020-12-31 |